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Friday, April 08, 2016

There is currently sufficient evidence that nonuterine high-grade serous
carcinoma (HGSC) originates in the fallopian tube in the majority of
cases, but this is not uniformly reflected in our diagnostic
terminology. This is because there remains wide variation in awareness
and acceptance of this evidence, which conflicts with traditional views
on origin. Accurate disease classification is fundamental to routine
clinical practice and research, particularly at a time when exciting new
approaches to therapy, early detection, and prevention are appearing on
the horizon. We feel the time has come to minimize individual and
institutional variations in practice, and agree on an evidence-based
approach to uniform terminology and primary site assignment. In this
paper we put forward a proposal for a unified approach based on
published research evidence and discuss the reasons why it is vital to
agree on a uniform protocol. We propose the term “Tubo-ovarian HGSC” in
preference to “pelvic” or “Müllerian,” as it accurately reflects the
origin of this disease in the vast majority of cases, and is
unambiguous, distinguishing it clearly from uterine serous carcinoma and
ovarian low-grade serous carcinomas. A detailed protocol for primary
site assignment is presented for different scenarios, which is easy to
follow and has been developed with a view to promoting a uniform
approach worldwide.